BOOK REVIEW: 'Island Practice': Quirky, Controversial Nantucket Doctor Timothy Lepore Harks Back to an Earlier Time of Family Medical Practice

Reviewed by David M. Kinchen
BOOK REVIEW: 'Island Practice': Quirky, Controversial Nantucket Doctor Timothy Lepore Harks Back to an Earlier Time of Family Medical Practice

Dr. Timothy J. Lepore (pronounced to rhyme with peppery) has earned a reputation as an idiosyncratic, contrarian family practice physician in his decades on Nantucket Island, but, as Pam Belluck shows in her very readable book "Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor" (PublicAffairs, 272 pages, no index, $25.99) he's really a survivor from a not-too-distant past when family doctors were not as money-driven and impersonal as they've been forced to become in today's medical-industrial complex.


Since moving to Nantucket in 1983 with his understanding beyond belief wife Cathy, Lepore has treated Jimmy Buffett, Chris Matthews, and various Kennedy relatives, but he makes house calls for anyone and lets people pay him nothing—or anything: oatmeal raisin cookies, a weather-beaten .44 Magnum revolver, a picture of a Nepalese shaman.


"Cobblestone rash"? Belluck says it's an equal opportunity malady resulting from slipping or falling -- or stumbling drunk -- on Nantucket's picturesquely uneven streets. Related to this are moped accidents. Dr. Tim to the author: "I've told people if they want the moped experience they could just let me hit them with a bat and then go over them with a sander."



BOOK REVIEW: 'Island Practice': Quirky, Controversial Nantucket Doctor Timothy Lepore Harks Back to an Earlier Time of Family Medical Practice

If you need an appendectomy, Lepore can do it with a stone scalpel he carved himself. If you have a condition nobody can diagnose—"creeping eruption" perhaps—he can identify what it is, and treat it. A baby with toe-tourniquet syndrome, a human leg that's washed ashore, a horse with Lyme disease, a narcoleptic falling face-first in the street, a hermit living underground — hardly anything is off-limits for the 67-year-old physician who has a stuffed armadillo on display in his office.


The Big Pharma commercials where the narrator urges us to "ask your doctor" make me want to scream at the TV screen. Who has a doctor who has time to sit down and talk about medications? He or she is too busy running in place to make a living in a world driven by insurance companies and, increasingly, federal regulations that take the fun out of medical practice.



Belluck's book, replete with examples of Lepore's idiosyncrasies, asks the question: Can a maverick like him survive as a healthcare chain takes over his small hospital, forcing him to follow the rules that he had routinely rejected? "Island Practice" suggests that doctors like Tim Lepore are a thing of the past, that future doctors on the island will be without his quirks. I agree. Once you accept the concept of conformity, it makes life easier, just as the pod resisters in "Invasion of the Body Snatchers" discovered that all their problems ended when they went to sleep.


Nantucket County, Mass., incorporating Nantucket Island and the tiny islands of Tuckernuck and Muskeget, has since 1992 been in the top three counties in the nation for cases of Lyme disease, spread by ticks who feast on deer and nest in their hides. Lepore, a gun enthusiast and hunter, has for years called for increased harvesting of the deer on the island to reduce their population -- and lessen the prevalence of Lyme disease -- a sound practice that has produced a lessening of Lyme disease elsewhere in New England. For his efforts, he has often faced the wrath of the urban dwellers who visit the island and view deer as charming accessories on a quirky island 30 miles from the mainland. For more on Lyme disease, named after the town of Old Lyme, Connecticut, at the mouth of the Connecticut River, click:


Pam Belluck
Pam Belluck

The "Bambi" syndrome has resulted in a population explosion of deer, making the place dangerous for those who fear the disease. In Chapter 4: "Moby-Tick" (beginning on Page 53) Belluck writes about Lepore's obsession with Ixodes scapularis, the tick whose bite can lead to Lyme disease and the less well-known but potentially deadly babesiosis and anaplasmosis. Thanks to this obsession, Lepore has become the nation's go-to guy for information on Lyme disease. To show the prevalence of Lyme disease -- which scares the hell out of me to the extent I refuse to visit any place where it is common -- I'm including with this review a map of the country showing where the disease is most common; New England, including Nantucket Island, is the nation's hot spot.


If you were as entranced as I was with John Berendt's "Midnight in the Garden of Good and Evil" and Susan Orlean's "The Orchid Thief", you'll find similar pleasures in "Island Practice." Belluck introduces us to Thomas Johnson, AKA "Underground Tom," an elusive Nantucket resident who lives in tiny subterranean houses he illegally excavates in such places as the island's Boy Scout Camp. Most people believe Underground Tom has left the island, but who knows for sure?



About the author


Pam Belluck has been a staff writer for the New York Times for more than fifteen years, during which she has written about everything from cattle rustling to embryo adoption, reported from places as diverse as Medellin, Colombia, and Seongham, South Korea. She served for more than a decade as national bureau chief, covering some of the biggest stories for the paper. She is currently a health and medical writer for the Times. She has won several awards, a Knight Fellowship, and a Fulbright Scholarship.
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